Monday, August 10, 2015

Eating Disorders and Other Fun Things about Being Fat

This sign serves as your warning that this post is wordy, and touches on topics I said I wouldn't talk about here! (image via)

Any website or literature dedicated to eating disorders worth anything will tell you the ABCs of eating disorders. A is for anorexia. B is for bulimia. C is for compulsive overeating (clinically called Binge Eating Disorder, but then the trinity of eating disorders couldn't be cutified with the adorable "ABC" reference if it was called by its clinical name, could it?). I felt like some kind of bizarro-world cheerleader just then. Of all those disorders, the one that tends to get the least attention... in the media, in studies, in Lifetime original movies... is binge eating disorder. Of the three, it is the one that can seem the least like an actual "problem", even to those who suffer from it. But it's time for me face the facts, it's still an eating disorder. And its long lasting effects are just as life threatening as those that come from the other two disorders. It is often misunderstood and misdiagnosed, being characterized as "just a weight problem." Even as a doctor can look you in the eye and use the words "develop a better relationship with food," it makes your soul die a little when their next words include "weight loss surgery." Recognizing that someone may be suffering from binge eating disorder - AN EATING DISORDER FULLY DEFINIED AND RECOGNIZED IN THE DSM-V - and recommending that they simply "work on healthier eating habits," "get more exercise," or have their digestive system surgically altered to completely force a change in the way their body handles food and nutrition is something I can only liken to telling an alcoholic to "just drink a little" or advising someone with anorexia to "have a burger." It's one thing to try and overlook a seemingly well-meaning friend or family member completely missing the mark in in their inability to understand the complexities and deep rooted self-loathing that drives an eating disorder. But when your doctor minimizes one of these should-be obvious mental illnesses (I seriously HATE using that term, seriously, but I have committed to calling a spade a spade today) with a treatment plan of Weight Watchers, joining a gym, and offering to prescribe Meridia, that is borderline malpractice in my opinion.

I will only allow myself a short tirade on the topic of weight loss surgery today. I think weight loss surgery, such as the Lap Band, gastric sleeve, and Roux En Y traditional permanent alteration of one's gastric system can definitely be a helpful tool for someone who clinically qualifies for it…AND WANTS IT. But it should be viewed as just that, a tool. It also is important to find a team who will require the potential surgical candidate to go through the full gamut of diagnostic interviews and tests to ensure they are physically and mentally a good candidate for this method of treatment. Having surgery to essentially force your body into a new way of eating and digesting can help you lose weight but it can also be psychologically devastating if you have a skewed relationship with food.

Imagine that every day, for twenty five years, you woke up in the morning and before you did anything else, you used your fingernails to gently scratch your ankles. Sure, sometimes you got carried away and drew a little blood, but come on, it's fine. And doing this is has become ingrained habit, I mean, you can't imagine NOT starting your day like that...or doing it again four or five more times each day. In fact, most times, you don't even think about it; it just happens.  Then your doctor tells you that, for your health, you have to stop. You try, you really do, you give it 110% effort... but you always seem to slip back into old ways. So your doctor schedules you for surgery to remove your fingernails. You go through a few weeks of pre-surgical counseling and you're able to tell everyone what you know they need to hear to make this surgery happen, because you've been convinced that this is it... this is your golden ticket. The day comes and you finally have that surgery that's going to be your miracle cure. You wake up from the anesthesia groggy and a little sore but optimistic about your future.  Then, you realize that the pain you're feeling isn't just post-operative, recovery pain, it's because you're trying to scratch your ankles with your bloody, bandaged, fingernail - less fingers and oh mY GAWD THIS F*N HURTS! And that's just beginning. Every morning, you forget, and go through the painful reminder of unconsciously going in for that scratch and being rudely jarred back to reality by that pain. Then, eventually, the pain subsides only to be replaced by emptiness when you absent-mindedly scratch and nothing happens. There's no more satisfaction or enjoyment or pacification. Now there's irritation, anger, resentment.  Why did you consent to, no, want that surgery? What were you thinking? So you get to that point where you can get through the day without scratching at your ankles. It's an hour to hour (hell, sometimes minute to minute) struggle but you can manage to get through your day without doing it. But you think about it all the time. You want to but you don't. You feel a profound sense of loss and start to feel depressed. Your doctor commends you on how great your ankles look and how you're on the path to a healthier you. Then the idea pops in your head that you don't need fingernails to scratch your ankles; you can use a tool. Hell, monkeys can learn to use tools. So, through trial and error, you slowly discover the best utensil to scratch. It may have taken a few years, but you find yourself exactly back where you were before the surgery, except now you have no fingernails.

I find this a good analogy particularly because of that last part. Not that all weight loss surgery patients regress and gain the weight back but it's possible and more common than you might think. Whether it's through eating small amounts too often or finding ways to eat the same, unhealthy foods that you've always craved (or both), without the proper and continuous support of the medical team for your physical and mental well-being, it is all too easy to render your surgery completely useless. It's also more physically dangerous to rebound gain after weight loss surgery. Compound that with the fact that you may or may not have also had cosmetic surgery to re-sculpt your slimmed down body, and now you're fat again. Add on the financial aspect, because your insurance not only denied coverage for the surgery to remove the excess skin, calling it not medically necessary, they also refused to cover the weight loss surgery, deeming it cosmetic. So, here you are, fat again and deep in debt from financing all that surgery. I mean no disrespect or shade toward anyone who's had weight loss surgery; I think you have incredible strength and bravery...I'm not sure I could do it, even if my insurance would cover it.

OK, so I guess that wasn't as short as I had intended. Sorry about that.… moving on.

It's also important to mention that it is very common for eating disorders to "cross-over;" meaning, people who suffer from one often find themselves suffering from one or both of the others. To be real about it, I have had past episodes that would clinically qualify as bulimia. Having a psychological fear of throwing up, no, I have never induced vomiting, but only because that was too scary for me. But I have abused laxatives and diuretics. Purposely taking three times the recommended dose of an over the counter laxative after eating a Big Mac value meal, an entire pizza, bag of Tositos with cheese dip, pint of Ben and Jerry's, and half a package of cookies definitely meets the diagnostic definition of bulimia. Where I can count the number of times I have done that without taking off my shoes, the mind-set is still there, bubbling under the surface. I have also had the passing thought, "God, I wish I could just stop eating." Yes, I have wished for anorexia. And, yes, I also understand how damaged that is.

This is where I struggle the most with the recent body love movement. I want to love my body enough to stop abusing it. Abusing it by living to eat rather than eating to live. That's another cliché that makes me cringe but I really can't put it in better terms. So much of the rhetoric and treatment for eating disorders focuses on finding your triggers and "mindful eating." I can assure you, when I'm eating, everything else is already tuned out. Because I love food. I love the way it tastes. The way the combination of smoky charbroiled meat coupled with mild, tangy cheese, crisp lettuce, and creamy mayonnaise can create the perfect cheeseburger. Or the dense, softness of yellow cake shrouded in the balanced sweetness of buttercream frosting with just a tiny hint of fine, granular sugar crunch. Let me repeat that...I love food. When there is just no "underlying trauma" causing you to binge, where do you go with that? How do you "fix" that? When you find it impossible most times to not eat that entire pizza or cake because it just tastes SO F*N GOOD, how do you stop?

I have had my experiences with most aspects of mental health care (again, I'll visit that another time) and can unequivocally say that therapy is not helpful for me, group nor individual. I've had brief stints as an inpatient, gone through structured intensive outpatient programs, participated in support groups, women's therapy groups, and a combination of years of one on one therapy. Mind you, none of that was specifically to treat my eating disorder (probably because it's taken me years to realize I have one and, at the time, my "mental health team" had labeled me with other maladies that trumped my fat). None of it worked to helped me.

During all of this one on one therapy, sometimes weekly, sometimes every two weeks, I stuck with one therapist for two years, accomplishing nothing. I finally moved on to a new one after realizing that my therapy sessions were nothing more than a 50 minute coffee break for both of us. It only took 9 months with the new therapist to get to the same place. There were others sprinkled in between that I just couldn't click with. I did whatever they asked of me. If they wanted me to journal, I journaled. If they wanted lists, I made lists. If they gave me worksheets and goal exercises, I completed them and brought them next visit. It always ended up feeling like chatting with a girlfriend. They spoke of their personal lives, I could never tell if they were doing that as a method of trying to "connect" with me, or if they were aware that I wasn't reaping any clinical benefit but they didn't know how to tell me that "our time was up," permanently.  As much as we mutually tried to keep it clinical, it just never felt that way. In the structure of the outpatient program, it was the same but different. I did all the work and activities... the worksheets, the art therapy, the group participation... and walked away everyday feeling no different. It was just never something that I found helpful.  That leaves me asking myself, why would it be any different for the eating disorder?
I've done Weight Watchers a handful of times beginning when I was a teenager. My least favorite part was always the group discussion. I never found it helpful and always wanted it to be over before it started. I've tried online weight loss support sites. They stick for a while but then I get bored and irritated with the whole social aspect of it.  Now I want to clarify, I am not comparing weight loss support with clinical support to treat an eating disorder. I am merely presenting the fact that other forms of group support weren't helpful to me either. That is, until I found Tumblr.

There’s just something about it. Maybe it’s the perfect mix of photos, silliness, motivational quotes, heart-felt admissions, and what seems like the genuine support of my newfound Tumblr friends. It’s something that I know I don’t have to do, but I am compelled to visit each day. I’ve taken to sharing screen shots of my FitBit activity and LoseIt! daily food log. I also occasionally snap and share photos of the produce I use to make juice along with the results, as well as some of the healthier food I’ve been preparing for myself. I had forgotten what a great cook I can be. More than anything else, it gives me just enough of a feeling of being accountable to want to continue. Even if it’s sharing how I totally abandoned healthy choices for a weekend in favor of delivery and baked goods.

I know this blog isn’t about my weight, or my health related lifestyle changes. And it’s so hard for me not to write on here as much as I'd like to. As much as I love Tumblr, it really isn’t a venue for long, wordy posts like I put here. I also don’t want to alienate any of the people who look forward to reading my stuff on here. So I will stick to my promise to not turn Big Funny Girl into Look What I Ate Today or My Daily Workout. If it occasionally slips in…kind of the way it did a bit here, I’m sorry. This new healthy outlook has become a big part of my life, it’s hard not to talk about it! I'll try and post the funny goods here a bit more often.

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